Hydronephrosis of the kidneys in adults

With hydronephrosis of the kidneys, the outflow of urine is disturbed. The disease can affect both one and both kidneys – the latter option is rare, in 5 – 10% of cases. In chronic hydronephrosis, complete loss of kidney function and removal of the affected organ is possible.

The kidneys are located at the back wall of the abdominal cavity. During normal operation, filtered urine enters the renal pelvis, and then through the ureters enters the bladder, where it is excreted from the body through the urethra.

Hydronephrosis affects the tissues of the kidneys, impairing the functioning of the organ. This is due to a violation of the outflow of urine – it accumulates in the kidney, increasing pressure and forcing the pelvicalyceal system to expand. Since the kidneys work under a huge load – in just 5 minutes they filter all the blood – a violation of the outflow greatly affects the condition of these organs.

In young and middle age, hydronephrosis often affects women, as it is provoked by pregnancy and oncogynecological diseases. And after 60 years, the disease develops mainly in men, due to age-related diseases of the prostate gland. Basically, this problem is congenital, found in childhood.

What is kidney hydronephrosis

The tissues of the kidney form urine, which enters the pelvicalyceal system. Hydronephrosis disrupts this conduction, and urine begins to pool as the kidney tissues continue to work and continue to pump urine into an already overcrowded system. This leads to an increase in hydrostatic pressure in the system. If no action is taken, the calyx or pelvis may rupture, and urine will fall directly into the retroperitoneal space, threatening the work of other organs.

Another possible complication is urolithiasis and infection. The addition of these diseases further damages the kidneys.

Kidney failure can also develop, and the kidneys stop working. Because of this, the blood is not filtered, it is not cleared of residual nitrogen. Intoxication is growing, which can lead to death.

Causes of hydronephrosis of the kidneys in adults

The cause of hydronephrosis is often the congenital structural features of the urinary tract. Obstruction may be due to the location of the renal artery, while it compresses the ureter. The ureter itself can also be incorrectly located, or its narrowing, congenital valves are observed. With such pathologies, surgical treatment is necessary.

Acquired hydronephrosis develops as a result of complications of other diseases of the genitourinary system. Inflammatory diseases, tumors, stones, injuries disrupt the outflow of urine.

Symptoms of hydronephrosis of the kidneys in adults

One of the main dangers of hydronephrosis is inconspicuous symptoms. The disease often does not manifest itself at all in the early stages. When symptoms appear, it is easy to confuse them with other diseases, since there are practically no signs that are characteristic only of hydronephrosis.

Patients often experience mild aching pain in the lower back – they can be paroxysmal or almost constant. Pain does not change in any way depending on activity, time of day.

With the development of hydronephrosis, nausea may occur, the abdomen swells, and with bouts of pain, blood pressure rises. The temperature rises rarely, and usually due to an attached infection, and not because of the hydronephrosis itself.

In 20% of patients, blood can be seen in the urine, in the rest only laboratory analysis will help determine it.

Treatment of hydronephrosis of the kidneys in adults

The treatment of this disease is carried out by a nephrologist, as well as a urologist. They can be contacted for advice if symptoms are present.

Conservative treatments focus on the consequences of the disease, not its cause. Medicines help reduce spasm, pain, relieve inflammation, lower blood pressure and pressure in the kidney.

All actions will be aimed at alleviating the patient’s condition and increasing the likelihood of preserving the organ. In the later stages, there is a high risk of loss of kidney function, and life is impossible without them. Conservative treatment often serves as a preparation for the next stage – surgery.

Diagnostics

When diagnosing, the doctor listens to the patient’s complaints, and then palpates the abdomen. In thin people and children, you can feel a distended bladder, an enlarged kidney. When tapping the abdomen with hydronephrosis, tympanitis is detected – a loud high-pitched sound.

Next, blood and urine tests are ordered. Blood is found in the urine, and laboratory parameters also allow you to find out if infection and inflammation have joined. Blood biochemistry is characterized by an increased level of urea, creatinine, electrolyte balance is disturbed. If necessary, various urine samples are prescribed: Zimnitsky, Nechiporenko and others. For this, urine is collected in several jars at regular intervals.

It is very important to study the condition of the kidneys, to find out the degree of expansion of the pelvicalyceal system, to exclude the presence of stones. This helps ultrasound, as well as intravenous urogram. A contrast is injected into the vein, which is then excreted in the urine – this helps to track the entire work of the urinary system.

The state of the renal tissues is assessed using MRI and CT, radioisotope studies, and angiography.

Endoscopy is used to accurately determine which obstruction is blocking the outflow of urine – a flexible tube is inserted to examine a specific area. Depending on this study, they have a different name: ureteroscopy, nephroscopy, etc.

Modern treatments

One of the emergency methods of helping with hydronephrosis in the acute phase is nephrostomy. With this procedure, pressure in the kidney is urgently reduced by removing urine through a nephrostomy catheter. One end is placed in the pelvis of the kidney, the other is brought out.

The type of surgical treatment of hydronephrosis is determined by the doctor after a deep diagnosis, preparation of the patient. Operations vary greatly depending on the condition of the organs. Of course, first of all, they try to make a reconstruction, correct the pathology and save the organ.

But in severe cases, organ-removal operations are performed when the kidney is so damaged that it needs to be removed. Preservation of a kidney with impaired functionality is dangerous at a late stage of the disease, especially for elderly patients.

Prevention of hydronephrosis of the kidneys in adults at home

With a tendency to diseases of the urinary system, it is necessary to visit a urologist and a nephrologist in time, treat all infections so that they do not provoke hydronephrosis.

It is worth avoiding hypothermia, hitting the kidneys, and eating right. Some foods retain water, overloading the kidneys and increasing blood pressure: salt, alcohol, and others. They should be excluded from your diet.

Popular questions and answers

Hydronephrosis is a dangerous disease, as a result of which you can lose your kidneys. About situations in which it is necessary to urgently consult a doctor, we will be told urologist, candidate of medical sciences, head of the department of urology, GKB named after I.I. V.V. Vinogradov Sergei Belomytsev.